Confusion over giving antivirals to children with flu

Some governments, including the UK’s, insist that everyone with swine flu should be offered antivirals as part of a “safety first” strategy.

But the new study, published in the journal BMJ, suggests the strategy is misguided.

Small help

It concludes that treating children under 12 with antivirals does very little, shortening the duration of disease by just a day or so, and decreasing by just 8 per cent the likelihood that an infected child will spread it to others.

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Also, Tamiflu causes additional vomiting in 5 per cent of children already vomiting because of their illness. Nor does it bring any benefits for asthmatics, as implied by advice from the UK government’s Health Protection Agency.

“The results show the effect is fairly small for most children,” says Matthew Thompson of the University of Oxford, who led the research.

His team’s advice is for parents to treat mild flu symptoms with the usual medicines for controlling fever, plus plenty of rest and fluids.

Value unknown

Even if complications develop, the value of giving antivirals to children is unknown, the researchers say. “What we need are studies large enough to let us know if antivirals reduce the risks of serious complications such as pneumonia or hospitalisation in children,” Thompson says.

Responding, the British government’s Department of Health said that the BMJ study is based on seasonal flu and so may not apply to swine flu.

“Whilst there is doubt about how swine flu affects children, we believe a safety-first approach of offering antivirals to everyone remains a sensible and responsible way forward,” said a spokesperson. “However, we will keep this policy under review as we learn more about the virus and its effects.”

Thompson accepts that his review only looked at seasonal flu. “But about two-thirds of the studies were influenza A, which is what the current strain is,” he says. “So we would expect our results to be applicable to swine flu.”

Sharp shooting

Thompson says that other countries are deploying a more targeted approach, unlike the scattergun approach in the UK. “For example, Canada, Ireland and the US are only recommending antivirals for patients at particularly high risk, or with severe illness,” he says.

“It may be worth the Department of Health taking the new research on board and perhaps having a more targeted approach to the use of antivirals, or urgently conducting randomised controlled trials of children and adults to identify whether there are subgroups of children who will benefit from antivirals, and whether they do have an impact on severe complications such as pneumonia or hospitalisation,” says Thompson.

“I hope the evidence from such trials will help parents and family doctors make sensible decisions about which children to treat.”